Diagnosis
Î Clinicians should suspect the diagnosis of NVO in patients with new or
worsening back or neck pain and:
• fever (S/L).
• elevated ESR or CRP (S/L).
• concomitant bloodstream infection or infective endocarditis (S/L).
Î Clinicians may consider the diagnosis of NVO in patients who present with:
• fever and new neurologic symptoms with or without back pain (W/L).
• new localized neck or back pain, following a recent episode of S. aureus bloodstream
infection (W/L).
Î IDSA recommends performing a pertinent medical and a motor/sensory
neurologic examination in patients with suspected NVO (S/L).
Î IDSA recommends obtaining bacterial (aerobic and anaerobic) blood
cultures (two sets) and baseline ESR and CRP in all patients with suspected
NVO (S/L).
Î IDSA recommends a spine MRI in patients with suspected NVO (S/L).
Î IDSA suggests a combination spine gallium/Tc99 bone scan, or
Computerized Tomography (CT) scan or a Positron Emission Tomography
(PET) scan in patients with suspected NVO when MRI cannot be obtained
(e.g., implantable cardiac devices, cochlear implants, claustrophobia, or
unavailability) (W/L).
Î IDSA recommends obtaining blood cultures and serology tests for Brucella sp.
in patients with subacute NVO residing in endemic areas for brucellosis (S/L).
Î IDSA suggests obtaining fungal blood cultures in patients with suspected NVO
and at risk for fungal infection (epidemiologic risk or host risk factors) (W/L).
Î IDSA suggests performing a purified protein derivative (PPD) test or
obtaining an interferon gamma release assay in patients with subacute NVO
and at risk for Mycobacterium tuberculosis NVO (TB NVO) (i.e., originating
or residing in endemic regions or having risk factors) (W/L).
Î In patients with suspected NVO, evaluation by an infectious diseases
specialist and a spine surgeon may be considered (W/L).
Î IDSA recommends an image-guided aspiration biopsy in patients with
suspected NVO (based on clinical, laboratory, and imaging studies) when
a microbiologic diagnosis for a known associated organism (S. aureus, S.
lugdunensis, and Brucella sp.) has not been established by blood cultures
or serologic tests (S/L).
Î IDSA advises against performing an image-guided aspiration biopsy
in patients with S. aureus, S. lugdunensis or Brucella sp. bloodstream
infection suspected of having NVO based on clinical, laboratory and imaging
studies (S/L).
